1 Buckinghamshire Healthcare NHS Trust Nursing Quality Framework. IntroductionReducing harm and monitoring and improving the quality of nursing care delivered to patients is an essential element of the role of all nurses. Whilst there are systems in place within Buckinghamshire Healthcare Trust, they are not 100% robust and standards are not currently at the level aspired to by the Chief Nurse and her senior team.In order to address this, the Chief Nurse initiated a review of the quality framework, structure and monitoring; this paper outlines the improved system.BackgroundThe Trust Nursing Service is currently participating in a number of quality improvement initiatives and data collection/benchmarking/monitoring systems including Safety Express, Safety Thermometer, Essence of Care, Releasing Time to Care (Productive ward) and there is encouragement from the Strategic Health Authority to enlist in ‘Energising for Excellence’ the latest initiative from the NHS Institute for Innovation and Improvement (NHS Institute). This has resulted in the requirement for comprehensive data collection by ward managers, matrons and others across a wide range of indicators. This takes a significant amount of time to collect and present; some is on display at ward level though it may sometimes be of little meaning to patients and members of the public.‘Harm Free’ CareThe Safety Express programme, a powerful measurement system and support, encourages organisations to stop thinking about individual safety issues in isolation and to think about complications from the patient’s perspective. It has focussed on four key harms – pressure ulcers, VTE, urinary catheters and falls – and its aim is the absence of all four harms and achievement of harm free care.Harm free care is regarded as ‘a new mindset in patient safety improvement’. BHT’s Chief Nurse contributed to the product design and the Trust Nursing Quality Framework incorporates key elements.
2 Energising for Excellence Text taken from the Department of Health website“Energise for Excellence in Care (E4E) is a quality framework for nurses, midwives and health visitors which aims to support the delivery of safe and effective care, creating positive patient and staff experiences that build-in momentum and sustainability.The framework brings together numerous tools, techniques and policies from both a national and local level into one central portal, which is now available from a dedicated section on the DH website.E4E provides information at the point of care, supporting nursing staff to improve the quality of care and productivity. Good quality, safe effective care improves the experience of both patients and staff, resulting in shorter hospital stays, less patient complaints and fewer staff absences and errors.Nurses are the biggest workforce in the NHS and the E4E approach gives them the chance to influence how they and their peers work. It empowers individuals to revolutionise the level of care given, increase productivity, reduce spend and ensure that the skill mix for a shift is appropriate to the type of patients on the ward. Understanding the acuity and dependency of their patients will assist nurses in having the right staffing levels to deliver the right care at the right time and in the right place.E4E is now strategically positioned as the over-arching approach to the implementation of improvement initiatives such as: High impact actions, Productive care, Safety Express, Essence of care. Many of these initiatives are not new and the emphasis is to pick and mix initiatives and ensure that improvement work is happening in each of the E4E domains: Get staffing right, Deliver care, Measure impact, Patient experience, Staff experience.”QUALITY PACK TMC dlb v
3 BHT NURSING QUALITY FRAMEWORK The Trust Nursing Service has developed a local version of E4E, based on the work of the NHS Institute and using the same five elements. It also incorporates the primary drivers and many of the secondary drivers of ‘harm free care’; the remaining secondary drivers form part of other structures and processes of the Trust e.g. Active Risk Management and Medicines reconciliation.The local nursing quality framework will be known as ‘Delivering Excellence in Nursing Practice’.Measure impactPatient experienceStaff experienceGet staffing rightDeliver careCONSISTENTHIGH QUALITYCARESafer Nursing Care ToolAUKUH Roster-proBirthrate+Releasing time to CareEssence of CareExec walkaroundsNational staff surveySafety ThermometerAudits, Matron RoundsPatient Experience TrackerPALS & ComplaintsNational SurveyGet staffing rightStaffing establishments have been reviewed using AUKUH (Association of United Kingdom University Hospitals)/ Safer Nursing Care tool.The Obstetric Service recognises the importance of the Birth-rate + workforce planning tools‘RosterPro’ is in place in most nursing areas and will be rolled out across the TrustDeliver CareThe Productive Team is well established and encouraging the use of the ‘releasing time to care’ concepts and toolsA planned programme of Essence of Care audits provides measurement of essential aspects of careStaff ExperienceThe Trust already has a system of Executive Walk-abouts in place and actively encourages staff to respond to the National Staff Survey.Local staff satisfaction measures are being developed and simple questions have been incorporated into the measurement frameworkMeasure ImpactThe measures to be used to assess the standards of nursing practice are detailed in the appropriate section below.Patient ExperienceThe framework builds on the existing system of Patient Trackers and the patient survey element of the Productive Team work as well as other feedback sourcesA Structure to Implement the FrameworkIt is acknowledged that measures and monitoring alone are not sufficient to support real sustained improvement; knowledge, education, and expert support are also essential. To this end a structure is proposed to support improvement in standards of patient care.
15 Patient promises … where your needs always come first LARGER DIAGRAMSPatient promises … where your needs always come firstClean and safe practice, clinics and hospitals so you never need to worry unduly A caring, helpful and respectful attitude from approachable teams, who listen to you, involve you in decisions about your care and ensure you’re clear about what to expect Respect for your time with care closer to home, offering choice and flexibility with a minimum of delays and cancellations Easy access to comfortable and modern facilities, offering privacy and dignity, personal space and good healthy food The best clinical care from teams of skilled healthcare professional, who help you improve and maintain your health
16 LARGER DIAGRAMS……I set the standard I am responsible for delivering a great service and am committed to my service standards pledges…..The standardCommentary & FeedbackThe competencyI say what is happening and whyCompassion & EmpathyI am caring and consider others’ feelings and needsI treat people with respect and dignityI act in a timely manner and communicate effectively whenever this is not possibleCommunication & DeliveryI am accountable for my actions and behaviours; I take ownership and do not pass the buckI keep patients and colleagues in the loopI listen to others, encourage conversation by using open questions and value other people’s views and opinionsCourtesy & ProfessionalismI am polite and approachable, courteous and attentive and welcoming at all timesI keep my eyes open and offer help and support to othersI am professional and positive; I am on stage – an ambassador for the organisation